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Saturday, October 10, 2015

PRIMARY DRUG ABUSE PREVENTION - Risk Factors and Protective Factors

by Brian T. Lynch, MSW

Every instance of drug use is also a
transaction between the users and the suppliers, whether the supplier is a
dealer, a friend trying to be helpful or a parent that leaves prescription
pills in easy reach. On the user side of the transaction the decision to
partake always meets some need or desire on the part of the user. How strong the need or desire to
take a drug is a variable, and therefore potentially controllable. It is
important to understand what needs are being met when a young person decides to
partake in drugs or alcohol. The lists below are among some frequent motivators
that lead to drug transaction and drug use. Each of these factors can be
modulated by family or community interventions. Still, this is just one side of
the transaction. On the other side of the equation is the availability and cost of the product
being consumed and the economic pressures on the supply side of the equation. Just
like any transaction, the lower the price or available the product the more
likely a transaction will occur. Factors affecting price and availability includes
not just law enforcement interdiction but market factors in the legal and
illegal drug trade, the strength of a profit motive for individual dealers, the
pain management and prescribing
practices of doctors, the economic pressures of small business owners selling
cigarettes or alcohol to minors, the amount of peer pressure being applied to
sell or give drugs to others, the vigilance of parents in keeping products in the
home out of the reach of their children, etc.

Primary prevention is all the things we can do
as families and a society to forestall or eliminate an individual's preliminary
exposure to addictive substances. It is the efforts undertaken to eliminate the
various needs (or demands) that initiate drug transactions in the first place.

The following is a collection of ideas on the
topic from a variety of sources with the URL links to some of the material and
my own thoughts provided in the bracketed text. My purpose is to initiate or
support public dialogue about what can be done to fix our drug problems. Let me
begin with some ideas as to why children try drugs in the first place.

Here
are some of the reasons young people have given for taking drugs :

To fit in
[The
need to belong and feel accepted and valued is a powerful and universal human need
that is denied to children who are marginalized, bullied or made to feel incompetent
in their social environment. This leads youth to seek acceptance in alternative
and sometimes more socially maladaptive peer groups where they are more at risk
for substance abuse. Making sure our youth feel connected, engaged and valued within their families and the community is a protective factor that reduces the risk
of substance abuse. Anti-bullying efforts in schools, identifying and intervening children who are being marginalized by their peers and teaching teachers how to be more effective manages the social milieu in their classrooms are other step that should be taken.]

To escape or relax
[The
ever growing competitive trends in education and youth sports programs has
placed unprecedented pressure on today's youth beginning at an early age. This
places youth at ever increasing risk of turning to drugs to relieve their
stress. Little league sports programs once focused on the social development
that helped children learn how to work together and support each other as a
team. Today there are increasing focuses on developing the individual talents of
star players and on winning as the major objectives. We may need to rethink our
whole approach to both academic achievements and youth sports programs. A
protective factor in preventing substance abuse might be to find ways to reduce
the stress we place on children in school and in organized sports.]

To relieve boredom

[Students
whose parents work and who are not in some after school programs come home to an
empty house. Some researchers say that the most at risk time for children to
abuse substances is this after school period before parents come home from
work. Younger children especially need guidance and leadership in structuring
their recreational activity. Children also need appropriate socialization
opportunities. Unstructured leisure time leads to increases in time spend on
passive entertainment such as watching TV or in playing video games or in
engaging in online activities such as chat rooms. These can lead to lethargy
and depression as well as boredom. It places kids at greater risk of substance
use to relieve boredom and depression. An
alternative would be after school efforts to help children identify and develop
their interests and skills other than traditional sports activities. We need a strength based approach to helping children
develop skills in dance, acting, music, art, debate,, chess and other such alternative
activities]

To seem grown up [There are several aspects to this one.
First, parents are primary role models in younger children. What parents
do helps define what seems normal for adult behavior. If parents smoke,
drink and use drugs this greatly increases the likelihood that their
children we try these activities as part of their social development. Then
there is the aspect of a child's exposure to the social behavior of older
cohorts in the family, schools or the community. To the extent that
substance abuse becomes a community wide problem the younger cohorts will
see the substance use by older youth as grown up behaviors. Then there is
the impact of media depiction of drugs on television and in the movies.
Parental monitoring and the exercise of discretion in what shows children
watch has an impact on a child's future behavior is an example of a
protective strategy to lower the risk of future abuse.]To rebel [I believe that
most youth rebellion has an origin
in family life. Dysfunctional families, overly lacks or severe discipline,
weak parent/child bonding, unreasonable expectations, parental hypocrisy,
cultural clashes between immigrant parents and children raised in American
culture, extreme economic or social stress are among the many factors that
can lead to rebellious youth. Children who can't relate appropriately to
family or social norms, can't respond positively to adult supervision and
guidance or who reject cultural norms are a great risk for substance
abuse. Every social policy and community based support system that
strengthens parents and families, prevents or ameliorates child abuse and strengthens family functioning help to protect children from substance
abuse as well.]

To experiment [For kicks! This is no small
reason. Researchers have discovered that the human brain is not fully
developed until a person is in his or her early to mid-twenties. The last area
of the brain to develop is the area responsible for evaluating risky
behavior and modulating impulsive behavior. Yes, there is a reason why
youth are impetuous. It is part of natures plan that young adults should
be risk takers. It is suggested that this help facilitate sexual exploration
and the necessary social separation that must take place for people to become
fully autonomous adults. Unfortunately it also promotes many other
risk-taking behaviors that never existed in our distant past. This now
includes experimenting with dangerous substances that can produce physical
addictions before people even realize they are addicted. Recognizing this, and
providing youth with developmentally appropriate information about the
risks associated with substance abuse is a protective factor. Enhancing risk awareness through public education increases the chances that youth will not engage in such risk taking behaviors.]

1. People suffering from anxiety, bipolar disorder, depression
or other mental illnesses use drugs and alcohol to ease their suffering.

[Early screening and identification of mental
illness or psychological disorders in children is essential to help prevent
substance abuse. They need both treatment for their condition, help in
developing social coping skills among their peers and the development of more
tolerance and understanding of mental illness in the general population to
reduce the stigma and added barriers that these children face.]

2. People see family members, friends, role models or
entertainers using drugs and rationalize that they can too. [What are your
thoughts?]

3. People become bored and think drugs will help. [What are your
thoughts?]

4. People think drugs will help relieve stress. [What are your
thoughts?]

5. People figure if a drug is prescribed by a doctor, it must be
ok.

[Here is where doctor's and the whole medical
profession needs to rethink their approach to pharmaceuticals in general and
pain management and mental illness treatment specifically. Pharmacies need to
keep better records that are regionally integrated with other pharmacies in
order to identify suspicious patters of certain classes of prescription drug sales.
Doctor's and medical staff need better training in identifying not just the
symptoms of drug addiction in patients, but in identifying patients who may be at
risk before prescribing potentially addictive drugs.

]

6. People get physically injured and unintentionally get hooked
on prescribed drugs.

7. People use drugs to cover painful memories in their past. [What are your
thoughts?]

[Let's not forget that addictive urges from
prior use of addictive substances is another major factor here. Researchers
have discovered that tobacco is so addictive that smoking just one cigarette for
the first time can produce neurochemical changes that trigger an urge for nicotine
up to six months later. This points up a curious aspect about addiction that is
often overlooked. Urges and desires have very different neurochemical origins
in the brain and urges are far more powerful controllers over our behavior. But
urges and desires are virtually indistinguishable from each other when we simply
choose to fulfill them, as we do in the early stages of addiction. It isn't
until we choose to resist the behavior to fulfill what we believe to be a desire
that we discover the full power that neurochemical urges have over our behavior.]

The following are selected excerpts from the Office of National Drug Control Policy - Preventing Drug Abuse

Prevention is most promising when it is directed at impressionable youngsters. Adolescents are most susceptible to the allure of illicit drugs. Delaying or preventing the first use of illegal drugs, alcohol, and tobacco is essential. Evidence from controlled studies, national cross-site evaluations, and CSAP grantee evaluations demonstrates that prevention programs work. Prevention programs are not vaccinations that inoculate children against substance abuse. Sadly, significant numbers of young people who participate in the best programs will go on to use drugs. The "no-use" message must be reinforced consistently by parents, teachers, clergy, coaches, mentors, and other care givers.

While all parents are critical influencers of children, parents of children aged eight to twelve are especially influential. Children in this age group normally condemn drug use. Such attitudes and attendant behavior are easily reinforced by involved parents. Parents who wait to guide their children away from drugs until older ages when youngsters are more readily influenced by peers or may have started using alcohol, tobacco, and other drugs, decrease their ability to positively influence children.

[This suggests that a comprehensive community drug abuse prevention program should include a parent education and guidance component for parents who have children between the ages of seven and eight years old. The idea would be to provide parents with the knowledge and guidance they need to strengthen their child's ability to refrain from initial use of harmful substances such as tobacco, alcohol, prescription or illegal drugs.]

Children whose parents abuse alcohol or other drugs face heightened risks of developing substance-abuse problems themselves. [Perhaps school based prevention programs should be routinely sending substance abuse educational materials and community treatment resource information home to the parents.]

There is significant evidence that carefully planned mass media campaigns can reduce substance abuse by countering false perceptions that drug use is normative. For all their power to inform and persuade, the media alone are unlikely to bring about large, sustained changes in drug use. https://www.ncjrs.gov/ondcppubs/publications/policy/99ndcs/iv-b.html

[Identifying specific individuals at risk for substance abuse and engaging them in a specific prevention effort is an effective component in a comprehensive community prevention plan. It requires the training and equipping of parents, teachers, physicians, coaches and others who have regular contact with young people in the community.]

[Some evidence] .. suggests that the most promising route to effective strategies for the prevention of adolescent alcohol and other drug problems is through a risk-focused approach. This approach requires the identification of risk factors for drug abuse, identification of methods by which risk factors have been effectively addressed, and application of these methods to appropriate high-risk and general population. http://psycnet.apa.org/journals/bul/112/1/64/

A general consensus in the literature on drug abuse prevention suggests certain school-based prevention programs can achieve at least modest reductions in adolescent drug use. http://www2.gsu.edu/~wwwche/drug%20curriculum.pdf

[School based substance abuse prevention programs can be an effective component of an overall community strategy for the early prevention of substance abuse. Research has identified eleven factors that contribute to successful school based programs. This information is helpful in selecting curriculum and evaluating school based treatment programs.]

ConclusionOnce a drug addiction problem become an epidemic in the community the pressure to act become overwhelming. The most immediate attention usually focuses on law enforcement interdiction of drugs and treatment for the addicted. These are expensive, complex and time consuming community actions that take time to ramp up and bear fruit. The pressure for law enforcement and treatment actions stretches local budgets and quickly overshadows our underfunded, under appreciated primary prevention efforts. Yet primary prevention efforts are the most cost efficient and effective methods to reduce our drug abuse problems. Arresting drug addicts doesn't reduce the availability or cost of the products. It is also ineffective if it doesn't involve treatment on demand for drug users. Treatment on demand requires more of a financial and social commitment than most communities can make. Interdicting drugs and arresting drug dealers can raise the cost and reduce availability of drugs, but if addicts go untreated this raises crime rates as they turn to criminal activity to pay for their habits. Unless there is a holistic, comprehensive and community wide approach to substance abuse prevention, where primary prevention efforts receive some priority, the problem of drugs will continue to a plague on our culture.